What Can Happen If a Cataract Is Left Untreated at a Very Advanced Age?

Relatives of very elderly people diagnosed with cataracts sometimes ask:

“My mother or father is very old. They sometimes also have problems with awareness. What happens if we do not treat the cataract?”

The answer varies from person to person.

This is because the decision about cataract surgery should be based not only on the eye examination, but also on the person’s general health, quality of life, daily needs and expectations.

Can a Cataract Improve on Its Own?

No.

Cataracts are generally progressive.

Over time, reduced vision, blurred vision, light sensitivity and difficulty with daily activities may occur.

If left untreated, vision may decline further over the years.

Does Every Cataract in a Very Elderly Person Need to Be Operated On?

No.

This is an important point.

For every patient, the aim is not simply to treat the cataract, but to assess whether surgery is likely to make a meaningful contribution to quality of life.

Particularly in very elderly people who are bedridden, have severe dementia or already have major limitations in daily activities, the decision may need to be assessed differently.

Can Reduced Vision Affect Quality of Life?

Yes.

In many older patients, reduced vision may:

• Reduce mobility
• Increase the risk of falls
• Make communication with the surroundings more difficult
• Reduce independence
• Increase confusion

For this reason, improving vision may provide greater benefits than expected in some very elderly patients.

How Is the Decision Made in Patients with Dementia or Problems with Awareness?

In this situation, the assessment should be more individualised.

The patient’s age alone is not the key factor.

The following questions are considered:

• What is the patient’s daily quality of life like?
• How much does the vision loss affect daily life?
• Is the patient expected to gain meaningful benefit from surgery?
• Can the patient cooperate during the procedure?
• Is the patient’s general health suitable?

The decision is often made through a joint assessment involving the patient’s relatives, the ophthalmologist and, when necessary, other physicians.

What Happens If a Cataract Becomes Very Advanced?

In some cases, cataracts that have been left untreated for years may harden, making surgery technically more difficult.

For this reason, postponing cataract surgery for a long time solely because of age may not always be appropriate.

Conclusion

Being very elderly or having certain cognitive problems does not mean that cataract surgery is always necessary or always unnecessary.

What matters is assessing the patient’s quality of life, general health and the potential benefit expected from surgery together.

The decision should therefore be based on an individual assessment rather than age alone.